A-fib surgery: Types, risks, and what to expect
Atrial fibrillation (A-fib) is an irregularity that can result in symptoms, such as heart palpitations, chest pain, and dizziness. However, some people may not experience any symptoms at all.
The Centers for Disease Control and Prevention (CDC) estimate that up to 6.1 million people in the United States may have A-fib. According to the World Health Organization (WHO), there are around 33.5 million people living with A-fib worldwide.
There are different treatment options for managing A-fib, including lifestyle changes, medications, and other nonsurgical options. While these treatments may help some people, they may not work for everybody and are not a cure. Doctors may consider surgery if a patient's medications aren't working and when nothing else has helped.
How is A-fib treated?
Treating A-fib involves preventing blood clots and lowering stroke risk. Other goals include controlling heart rate, restoring heart rhythm, and treating underlying disorders.
The first treatment for A-fib will be to live a healthful lifestyle and to quit smoking.
Lifestyle changes are a first treatment approach. People with A-fib should quit smoking, get active and stay active, lose weight, and eat a healthful diet. Patients may also take medications to prevent blood clots, control heart rate, and restore heart rhythm.
Rate control involves managing the per minute contraction rate of the ventricles (two large chambers in the heart that help pump the blood).
The heart needs a certain amount of time to circulate the blood and if it is able to work at a regular pace, people will experience fewer symptoms and will feel better. Restoring the heart's rhythm allows it to pump blood effectively throughout the body.
When medications aren't helping to restore normal heart rates and rhythms, the next step is electrical cardioversion.
Electrical cardioversion involves giving a person an electric shock outside their chest wall while they are under low-dose anesthesia. Like defibrillation, electrical cardioversion is designed to reset the heart rhythm. The only difference is that lower levels of electricity are used in electrical cardioversion than in defibrillation.
Whether this procedure is successful or not depends on what is causing the A-fib symptoms and how long the person has been having them. Most people get their heart rhythm back right away, but cardioversion is not a cure.
If A-fib symptoms return, another cardioversion is carried out. When cardioversion is combined with medications, the heart rhythm can stay normal for longer, which could be up to a year or longer.
The risks of cardioversion include skin burns, fluid buildup in the lungs, and an increased risk of heart attack or stroke. However, the success rates for returning the heart to a normal rhythm during the procedure or shortly after are over 90 percent. The potential for success may outweigh the risks, but people should still discuss any and all risks with their doctors.
A doctor may recommend surgery to treat A-fib when lifestyle changes, medication, and cardioversion are not helping. Surgical options include catheter ablation, maze surgery, or the insertion of a pacemaker.
Catheter ablation destroys faulty tissue that causes irregular heart rhythm.
Catheter ablation is an option for people whose medications are no longer effective and for those for who electrical cardioversion did not work or was not an option. Before the procedure, a doctor will do electrical mapping, which shows what areas of the heart are causing complications to its rhythm.
The actual procedure involves inserting a thin and flexible tube, called a catheter, into the blood vessels and guiding it to the heart. The purpose of catheter ablation is to destroy the faulty tissues that are sending irregular signals and causing the irregular heart rhythm.
It does this in one of three possible ways:
Once the faulty tissues have been destroyed, scarred areas will be left behind. This scar tissue will no longer send irregular signals and the heart will return to its normal rhythm. In some cases, however, A-fib will return, and ablation will have to be redone two or more times.
Catheter ablation is a minimally invasive surgical procedure and recovery time is generally short. A person will still need to take anti-arrhythmic drugs until the procedure takes its full effect.
The success rates for maintaining normal heart rhythms after catheter ablation is up to 90 percent. Success depends on how long an individual has had A-fib and its severity.
For most people, quality of life is significantly improved. A 2010 study found that 2 years after their ablation procedure, 72 percent of the 323 people surveyed were no longer taking A-fib medications.
The risk of life-threatening complications is around 1-2 percent. Other side effects are not life-threatening and include mild pain, bleeding, and bruising.
Surgeons will perform full maze surgeries when A-fib patients have open-heart surgery, such as a heart bypass or valve replacement. The reason for its name is the pattern created during the surgery.
Maze surgery will involve cuts being made in the heart and then sewn together to correct the heart's electrical signals.
During the procedure, the surgeon will make a number of cuts in a person's heart and then sew them together. Much like a catheter ablation, the resulting scar tissue will prevent the heart's electrical signals from crossing and allow them to function normally.
Risks include stroke, kidney and other organ failures, and death. Some people may need a pacemaker after the procedure.
The success rate after a maze surgery is 90 percent and current research shows that this rate continues to hold.
Mini-maze surgery is an option for those people who are not candidates for open-heart surgery. The mini-maze is a minimally invasive version of the full maze.
The mini-maze takes a few hours and involves the surgeon making three or four incisions on each side of the chest. The doctor will then insert surgical instruments, including an ablation device and a scope for viewing the chest wall. Ablation energy is then used to create a block to the pulmonary veins and stop the inconsistent electrical signals disrupting the heart.
The surgeon will also remove or cut away a small sac in the top left chamber of the heart, which reduces the potential for stroke and blood clots.
The current success rate for the mini-maze is 80 percent, and only 5 percent of patients who undergo this procedure will need a pacemaker.
A pacemaker is a small device that is implanted under a person's skin in the upper chest near the collarbone. Pacemakers do not actually treat A-fib, but use electrical pulses to monitor and regulate heart rhythm. A person may require a pacemaker after certain types of ablation or when heart medicine causes their heart to beat too slowly.
In some instances, doctors may use catheter ablation and implant a pacemaker.
Before a pacemaker is implanted, the surgeon will damage the tissue of the atrioventicular (AV) node, which is the place where the electronic signals of the heart travel from the upper part of the heart to the lower part. The pacemaker will then transmit regular heart rhythms.
Risks and benefits
It is very possible that people with A-fib can be cured, either through electrical cardioversion or surgery. Surgery is generally a last option.
People with A-fib who think that surgery is the right option for them should check with their doctors about the potential benefits and risks in having an ablation or maze procedure.